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WEEK 24:
Bone Repair:
| Question | Answer |
|---|---|
| Wolff's law | change in bone shape to match its function 'use it or lose it' (dynamic tissue constantly remodels and adapts itself in response to mechanical stress) |
| how does a fracture occur | repetitive force motions (running or physical work) common in athletes, single force traumas (falls or car accidents), and by disease that weaken the bone (osteoporosis or cancer) |
| factors affecting bones breaking | Load Rate Direction Bone properties Soft-tissue forces |
| general classifications of fractures (4) | open, closed, stable, and displaced fractures |
| open fracture | broken bone protrudes through skin |
| closed fracture | broken bone does not puncture skin |
| stable fracture | broken ends of bone are aligned |
| displaced fracture | broken ends of bone have moved out of alignment |
| complete fracture divisions (4) | transverse, oblique, comminuted, and spiral fractures |
| transverse fracture | break occurs at right angle to axis of bone |
| oblique fracture | at angle other than a right angle to axis of bone |
| comminuted fracture | complete and fragments the bone |
| spiral fracture | occurs by twisting bone excessively |
| cracked/ hairline fracture | aka stress fracture which is a small crack/ severe bruise within bone |
| greenstick fracture | incomplete break where part of bone is broken causing the other side to bend |
| buckle fracture | force put on one end of bone can make the side of the bone bulge out/ buckle without breaking the bone all the way through |
| avulsion fracture | bone is broken near a tendon or ligament and this tendon/ligament pulls off a small piece of bone |
| classifications of all fractures are named based on (3) | anatomical, mechanism of injury, and comprehensive (description) |
| anatomical classification of bone fractures | Proximal, Mid, Distal Intra/extra-articular (bone which forms joint with other bone) Displaced/Undisplaced Open/closed Simple/Multifragmentary |
| types of incomplete fractures (4) | cracked/hairline, greenstick, buckle, and avulsion fractures |
| why is classification of fractures important (4) | information sharing, guide treatment, guide prognosis, and research |
| mechanisms of injury as a classification for bone fractures | Bending, Shearing (forces act parallel causing bone to slide - pull), Compression, and Rotation |
| comprehensive (descriptive) as a classification for bone fractures | |
| types of mechanism of injury (5) | |
| displacement | STAR ((shortening (distance), translation (%), angulation (degrees), and rotation (degrees)) |
| diagnosis and imaging of bone fracture | history (mechanism), examination (look, feel, move), investigations (xray, USS- ultrasound, CT, and MRI) |
| xrays as a means of investigation | provide 2D representation of 3D structure - rule of 2s (2 veiws AP and lateral, of 2 joints above and below, 2 time before and after) |
| what does ultrasound USS show (3) | Hematoma, Joint effusion, and Tendon/Vascular injury |
| what does CT show | 3D reconstruction, Joint surface, Comminution, OR Angiogram (CT)- to view arteries |
| what does MRI show | Associated injuries, Ligament, Cartilage, Tendon, Stress fracture, (“dreaded black line” is a subtle radiographic sign for a unique type of high-risk stress fracture in anterior tibial cortex) |
| WEEK 1 | haematoma (inflammation ) |
| WEEKS 2-3 | soft callus |
| WEEK 4-16 | hard callus |
| WEEKS 17 and beyond | remodelling |
| types of healing (2) | contact (primary) and gap healing (secondary with callus formation) |
| ways of treating fracture | absolute and relative stability |
| Perren's strain theory | amount of fracture movement relative to fracture gap- different tissues tolerate different amounts of movement |
| how much movement in granulation tissue during healing | the most - up to 100% |
| healing within range for bone | fracture ends resorbed and strain reduced leading to differentiation of callus |
| healing above threshold bone forming | process impaired leading to non union (ends do not align) |
| treatment principles (4RS) | resuscitate, re-align (joint surface anatomical), restrict (minimise further soft tissue damage and stable biological fixation), and rehabilitate (early weight bearing) |
| treatment options | non surgical (analgesia, cast/splint/sling) and surgical (internal fixation and external fixation) |
| examples of internal fixation as a surgical treatment for fractures | k-wires, plate/screws, and intramedullary nail |
| casting | involves immobilizing and supporting broken bones with cast to promote proper alignment and healing by restricting movement given in 2 types of materials - fiberglass and plaster |
| principles of fixation | involves stabilizing broken bones using implants like plates/screws/wires either internally or externally to promote proper healing and alignments restoring is length, rotation, stability, and articular surface |
| fixations restores (4) | Length Rotation Stability Articular surface |
| internal fixation definition | surgical procedure to stabilize and support broken bones from inside the body using implants/ plates/ screws/ nails and wires - faster healing and reduced risk of improper healing |
| external fixation definition | surgical procedure using devices applied externally to stabilize and immobilize fractured bone particularly in cases of severe open fractures significant to swelling or bone loss to help proper alignment and healing |
| DCP | dynamic compression plate allowing linear compression across fracture gap using screws and a plate promoting bone healing through direct contact and stability |
| IM nail | intramedullary nail - long sturdy metal rods inserted into bones medullary cavity to align and stabilize fractures, secured with locking screws to prevent unwanted movements - minimise soft tissue injury |
| external fixation - 41 | temporary procedure and correction of deformity |
| what influences fracture healing | Injury factors Energy Environment Patient factors Compliance Comorbidities (eg diabetes) Surgical factors Suitability Stability |
| fracture complications | Immediate Haemorrhage Short term Compartment syndrome Neurological injury Fat embolus Mid term Infection Delayed/non-union Long term Loss of function Growth disturbance Arthritis |
| compartment syndrome | in fracture treatment occurs when swelling or bleeding within a muscle compartment increases pressure, restricting blood flow and causing severe pain often requiring emergency fasciotomy |
| fat embolus | release of fat particles from broken bones into bloodstream which causes blockages and potentially life threatening complications eg FES (fat embolism syndrome- where lungs are always involved then brain) |
| special complications (3) | Growth plate injury Non-accidental injury Fragility fractures |
| growth plate injuries | aka Salter-Harris fracture is an injury where growth occurs - involves epiphyseal plate/ growth plate commonly found in children and long bone fractures |
| SALTER classification in growth plate injury | S- straight accross A- above L- lower or below T- two or through ER- erasure of growth plate or CRUSH |
| non accidental injury | unexplained injuries in differing ages eg long bone fractures under walking age, metaphyseal corner fractures, posterior rib fractures in children (suspect abuse or osteoporosis) |
| fragility fractures | commonly in old age people where bones lose calcium becoming osteoporotic based on age, amount of force, and location of fracture |
| hip fractures | becoming increasingly common and becoming a rising socio-economic burden with around 50% deaths avoidable |
| NHFD and Best practice tariff** |
Created by:
kablooey
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